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Macular infarction after inadvertent intracameral cefuroxime
1From the Aintree University Hospital, Liverpool, United Kingdom.
Unlabelled:
We present the case of a 70-year-old patient who had uneventful cataract surgery. Because of a procedural mishap, the patient received an excess dose of intracameral cefuroxime of approximately 62.5 mg. Two weeks postoperatively, evidence of macular infarction with cystoid macular edema was seen on fundus fluorescein angiography. The patient was treated with 4.0 mg of intravitreal triamcinolone, but the visual acuity failed to improve; the final pinhole acuity was 3/60. Based on the postoperative progress, we speculate that a delayed mechanism of vascular toxicity is implicated. The importance of systematic procedures to reduce the risk for mistakes is emphasized, especially for a procedure such as cataract surgery where efficiency is increasingly important.
Financial Disclosure:
Neither author has a financial or proprietary interest in any material or method mentioned.
Insights
An excess dose of cefuroxime during cataract surgery caused macular infarction and vision loss. This case highlights the need for strict procedures to prevent medication errors in ophthalmic surgery.
Area of Science:
- Ophthalmology
- Surgical Complications
- Pharmacology
Background:
- Cataract surgery is a common procedure with a low complication rate.
- Medication errors, though rare, can have severe consequences.
Observation:
- A 70-year-old patient received an accidental overdose of intracameral cefuroxime (approx. 62.5 mg) during cataract surgery.
- Postoperatively, the patient developed macular infarction and cystoid macular edema.
- Intravitreal triamcinolone treatment did not improve visual acuity.
Findings:
- The patient's final visual acuity was 3/60.
- A delayed vascular toxicity mechanism is suspected as the cause of macular infarction.
- Excessive cefuroxime dosage is implicated in the adverse event.
Implications:
- This case underscores the critical importance of meticulous procedural protocols in ophthalmic surgery.
- Systematic checks are essential to minimize medication errors and prevent patient harm.
- Ensuring patient safety requires vigilance, especially in high-efficiency surgical settings.
